Take
Home Message: Lack of power, budget concerns, misconceptions about the role of
an athletic trainer, and rural location emerged as primary barriers to hiring
an athletic trainer by an Athletic Director in the public secondary school
setting.

In 2012 the Inter-Association
Task Force for Preventing Sudden Death in Secondary School Athletics Programs
published a consensus statement with the recommendation that an athletic
trainer (AT) be available for practices and competitions. While the national
average of schools employing ATs has increased in the last decade, only 42% of high
schools reported employing an AT. In current organizational hierarchy, hiring
and administration of secondary school ATs is typically the purview of the
Athletic Director (AD). Despite a rise in the national trend for employment,
barriers exist that prevent ADs from hiring an AT, even though they acknowledge
their importance in athletic health care. The purpose of this qualitative study
was to identify issues ADs face that prevent them from employing ATs in
secondary schools. Using data from the Collaboration for Athletic Training
Coverage in High Schools–An Ongoing National Study (CATCH-ON), the authors initially identified 1504
public schools that participated in the CATCH-ON and reported not employing an
AT. From that pool, the authors randomly selected a subset of schools and
categorized by geographic region (north, south, east, and west). The
researchers initiated contact with the ADs and conducted semi-structured
telephone interviews. Data saturation was reached at 20 participants. Questions
for the interview focused on AD perception of ATs, medical care provided for student-athletes,
and risk of catastrophic injury or death for student-athletes. Three major
themes emerged from analysis: lack of power as well as budget and non-budget
concerns. Lack of power was associated with ADs stating an inability to hire
and allocate a portion of their budget to an AT salary. Budget concerns were
centered on declining state and federal funding for public schools and school
board priorities to maintain teacher over AT employment. Non-budget barriers
included rural location of the school, misconceptions about the credentials and
role of an AT, and community interference (volunteers from the community
providing free emergency services).

Budget issues related to
hiring an AT are likely not a surprise; lack of funds due to state and federal
shortfalls have placed significant strain on school boards. ADs commented that
justifying an AT salary is difficult as teachers face potential job cuts. While
the concern is valid, it is also places student-athletes at risk. In a typical
organizational structure at the secondary school level, the AT reports to the
AD. The profession is just beginning to see a shift away from this model, with
collegiate athletic medicine programs being realigned with student health
services. One of the themes identified in this study was the misconception
about the role of an AT, in that a coach who is certified in First Aid/CPR is
equitable to a certified and licensed athletic trainer. If ATs were aligned
with the school’s nursing staff, the perception may shift away from a line item
in an athletic budget to ATs being viewed as a necessary part of the school’s
health care team. This study also reminds us that the sports medicine community
needs to target advocacy efforts not just at ADs but also at school boards.
These efforts may include a continued effort to educate school administrators
about ATs.

Questions for Discussion: How can ATs more
effectively promote our qualifications to better serve secondary school
athletes? Do you feel organizational alignment with a school’s nursing staff
could shift the perception of ATs in secondary schools?

4
comments:

Chris Donner
said...

I agree with what this article is saying. Many people have no idea what an athletic trainer is or what we do. I still have to explain to some people what I do for a living. I think that part of this has to do with the name of our profession. So many people call us "trainers" as opposed to "athletic trainers." This tells me that there is no awareness of what we do to the general public. Part of the fault could be on us. There are definitely times when I do not interact with parents like I should. If we all made a point to do this, then that would bring more awareness to the public about our profession.

I believe organizational alignment with a school’s nursing staff could shift the perception of ATs in secondary schools and strengthen healthcare at the secondary schools as a whole.This shift would have the potential to change public perception of athletic trainers as healthcare providers by aligning them with other health care providers in the school. It could also increase communication between the nursing staff and athletic trainers. In my previous experience working as an athletic trainer at a high school, the county’s athletic trainers and nursing staff were working together to help establish protocols rooted in improving communication between the two entities when caring for an athlete who had sustained a concussion. Athletic trainers are responsible for the wellbeing of an athlete who is concussed, but many do not work at the school during the school day. Therefore, the nurse would be responsible for the care of this athlete. By placing these health care providers in the same organizational hierarchy it could help facilitate communication and potentially improve healthcare for students during school and during sports participation for all medical needs beyond concussions.

Education for the public on what being an athletic trainer actually entails is needed. As a profession that is sometimes under-appreciated and misinterpreted within the community, it is our duty as athletic trainers and healthcare providers to educate others and advocate for what we do. If we aren't going to step up to the plate, then who is? If we sit back and complain about the lack of knowledge regarding our practice, and the disrespect we sometimes see from others, then no changes will be made and Athletic Director's will continue to struggle to come up with reasons why they should hire us. We need to get out in our communities and educate parents, coaches, teachers, and athletes about who we are, what we do, and why we are needed. It is essential to not just physically attend practices and competitions, but to make it known that you are there. In this way, members of administration and members of the community will be able to see the value in having an ATC, and that it goes beyond basic first aid skills.

While this article is frustrating to read (for obvious reasons), having worked in the high school setting I can also sympathize to the AD. AD's in our district were teaches who took the additional role for the extra stipend it brought with it. Many had a good idea as to what I did but I can understand why an AD would not feel as though they could make any difference in getting a AT hired. They took the job as extra money, and therefor did not have the resources to or hierarchy to get someone hired. But I agree with previous comments that the heart of the problem is our lack of education to the community about our qualifications. I think education is something that starts out small to gradually build over time. For example, our high school had a sports medicine class taught by the school's former AT, and every year there was a waiting list for it. Having a class like this teaches kids what our profession is about, but also gives them an opportunity to spread the knowledge they have learned to other to let them know why athletic trainers are necessary.

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